Core Stability Differs in Women with Chronic Pelvic Pain Compared to Healthy Controls

To determine if women with chronic pelvic pain (CPP) have reduced core stability and aerobic or resistance physical activity levels (aPA, rPA)compared to women without CPP and to assess for correlation between core stability and pelvic floor muscle (PFM) strength in women with CPP.

Methods: This prospective, observational study recruited women aged 18-70 with CPP (defined by ACOG) presenting to tertiary medical center outpatient clinics and compared them to women without CPP recruited from a concurrent study. Patients were excluded for pregnancy, neurological diseases, current lower extremity or shoulder injuries, abdominal or pelvic surgery in the last 8 weeks, current lower back pain, and non-English speakers. Participants completed a study packet including demographics, Godin Shepherd Leisure Time PA Questionnaire (“Godin”), and a novel Resistance Activity Questionnaire (RAQ). Core stability was assessed using the “Core Score,” 4 exercises (single-leg squat, supine bridge, side bridge, and prone bridge) graded on a scale of 0-3, then summed for a total “Core Score” of 0-12. Higher scores indicate increased core stability. Women with CPP underwent a vaginal myofascial PFM exam to assess pain and muscle tone. Statistical analyses included: summary statistics (demographics), independent 2-sample t-test (core stability, CPP diagnosis), and simple and multiple linear regression models (core score).

Results: 42 women with CPP and 46 women without CPP participated with a mean age of 42 years, mean BMI of 30 and median parity of 1. Women with CPP were more likely to have lower BMI (p = 0.05) and history of back pain, constipation, IBS, interstitial cystitis/bladder pain syndrome, dysmenorrhea, dyspareunia, and anxiety (all p ≤ 0.01). Women with CPP reported mean pain of 3.5 and 5 out of 10 currently and over the last week, respectively. Women with CPP demonstrated lower overall core stability (p=0.04), and having CPP predicted a 2-point decrease in overall Core Score (p < 0.01). Women with CPP demonstrated significantly worse scores for the supine bridge (p < 0.01) and prone bridge (p=0.03). There were no significant differences in aPA or rPA between women with and without CPP . Finally, PFM strength on physical exam did not have a significant effect on Core Scores in women with CPP.

Conclusions: Women with CPP have significantly worse core stability than women without CPP, but aPA and RPAPA levels did not differ, contrasting prior research on patients with other chronic pain conditions. The lack of relationship between PFM strength and Core Scores in women with CPP indicates core instability extends beyond the PFM. Future directions will include larger, multi-center, randomized controlled trials to investigate specific exercises targeted at improving overall core stability in women with CPP.